Understanding Identity Disturbance

A Noticeably and Persistently Unstable Sense of Self

Medically reviewed by Steven Gans, MD

Identity disturbance describes an inconsistent or incoherent sense of self. It is associated with borderline personality disorder, as identity disturbance is one of the criteria for the condition. It often shows up as consistent and remarkable changes in a person’s beliefs, values, and behaviors that significantly impact their life, such as difficulty in maintaining jobs or relationships.

Research on identity disturbance is ongoing. More study is needed to help untangle the complexity of how identity disturbance is interpreted and connected to personality disorders.

This article discusses identity disturbance, what it is, and what causes it. It also looks at the treatments that are available for people with the condition.

Definition of Identity Disturbance

"Identity" refers to a person's sense of self. Your identity is how you see yourself in the past, present, and future, and it is generally consistent over time. A strong sense of self helps you maintain relationships and commitments and behave in predictable and consistent ways.

Identity disturbance is defined by the "Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition" (DSM–5) as “markedly and persistently unstable self-image or sense of self.” This might show up as dramatic, noticeable changes in self-image, conveyed by changing goals, values, and aspirations. However, there are still some gaps in how identity disturbance is defined and how it varies in people.

Identity disturbance is one of nine criteria for diagnosing borderline personality disorder, a serious mental health condition that causes unstable emotions, impulsivity, and changes in behavior. It is not clear whether it is only associated with borderline personality disorder. More research is needed.

Identity Disturbance Symptoms

• Identity disturbance is difficult to define because a sense of self and identity are complex in and of themselves. In other words, what it means to have an “unstable self-image” can be open to several interpretations. However, some signs that may point toward identity disturbance include:

• Contradictory beliefs, thoughts, and behaviors

• Changes in values

• Lack of commitment (e.g., to jobs or values)

• Feelings of emptiness

• Lack of core existence

• Lacking a sense of “I/me/myself”

• Feeling a painful lack of consistency in self

• Role absorption (i.e., defining oneself in terms of a single role and having the feeling of always playing a role)

One critical aspect of identity disturbance is having consistent and obvious changes in values, beliefs, and aspirations that severely affect everyday life, such as difficulty maintaining relationships or commitments and not having a sense of direction in life. A person with identity disturbance may behave inconsistently because of their difficulty in maintaining identity.

Of course, it’s natural to have changing beliefs, behaviors, and commitments throughout life. What sets identity disturbance apart is that it shows up as a very noticeable and consistent pattern of instability in one’s sense of self, and it significantly affects a person's life, including their direction in life or lack thereof.

Therefore, as with many mental health disorders, it is critical to consider external factors—such as stress, environment, socioeconomic status, and interpersonal trauma—that may be contributing to someone’s difficulty with maintaining a sense of self.

Causes of Identity Disturbance

Personality disorders are often stigmatized, and identity disturbance is no exception. Though it is not known what exactly causes identity disturbance, social causes, such as abandonment and invalidating relationships, may be at play.

Takeaway

Identity disturbance is one of the criteria for diagnosing borderline personality disorder. At this time, none of the other personality disorders shares this same criterion, though researchers don't know for sure if identity disturbance can be associated with other conditions.

Identity disturbance is a key symptom of borderline personality disorder, though it is unclear whether identity disturbance can exist on its own. Thus, it is difficult to parse out what exactly causes identity disturbance.

It may be that the key components of borderline personality disorder, such as emotional instability, which, in itself can lead to unstable moods, behaviors, and relationships, causes someone to struggle with identity.

For example, if someone experiences unstable behaviors and emotions, maintaining relationships and a daily routine (a job, for example) is difficult. This can lead to a sense of unstable self-image, as interpersonal relationships and commitments impact how we see ourselves.

Some causes of borderline personality disorder might also be shared in identity disturbance since the two are intertwined. Causes of borderline personality disorder include:

• Family history

• Brain chemistry (i.e., changes in parts of the brain that control impulses and emotional regulation)

• Environmental and social factors (e.g., traumatic life events; instability, invalidating relationships; hostile conflicts)

Overall, the exact cause of identity disturbance is not well understood. Although its association with borderline personality disorder does give us some insight, more research is needed before researchers will fully understand its causes and risk factors.

Treating Identity Disturbance

Since identity disturbance is a key component of borderline personality disorder, some borderline personality disorder treatments may also work for identity disturbance, including:

• Dialectical behavioral therapy: The goal of dialectical behavioral therapy is to decrease emotional instability by using the concept of mindfulness. Working on emotional regulation may help someone with identity disturbance since emotional instability may make it harder to maintain a stable sense of self.

• Cognitive behavioral therapy: This type of therapy can help you identify and change the thoughts or behaviors that cause inaccurate perceptions of yourself and others. This can make it easier to maintain a more stable self-image and, as a result, relate better to others. CBT can help treat identity disturbance because it focuses on changing patterns of unhelpful thoughts and behaviors.
  

• Mentalization-based treatment: This is a type of therapy used with people who have borderline personality disorder. It can help strengthen interpersonal skills and develop an understanding of others.
  

• Transference-focused psychotherapy: The goal of TFP is to help the person develop positive behaviors and a positive self-image. The term "transference" refers to the projection of emotions and feelings onto the therapist, which is believed to help them better understand your feelings and relationships.
  

• Schema-focused therapy: This uses psychotherapeutic techniques to help you recognize and change maladaptive thoughts that lead to self-destructive behaviors.

Medication is not usually used to treat borderline personality disorder because the benefits are unclear. Thus, medication may not be an appropriate treatment for identity disturbance either. However, a doctor or mental health specialist may prescribe medication to help with certain symptoms, such as depression and mood swings (i.e., emotional instability).

Summary

Identity disturbance is a persistent and noticeably unstable sense of self. It is a diagnostic criteria for borderline personality disorder.

People with identity disturbance can have trouble maintaining relationships, jobs, and a social life. The condition may be treated with psychotherapy.

Read the original article on Verywell Health.